BACKGROUND:cancer registries (CRs) are essential tools for oncological surveillance. The accurate coding of topography and morphology (through ICD-O-3 coding), traditionally performed manually, is complex and time-consuming. Artificial Intelligence (AI) offers new opportunities to automate this process, overcoming the limitations of existing algorithms, which often focus only on topography. OBJECTIVES:to develop an AI-based algorithm capable of automatically assigning the combined topography-morphology (topo-morpho) code from a synthetic clinical pathway expressed in natural language (LN-PDTA). DESIGN:retrospective observational study based on integrated registry and healthcare administrative data. Deterministic record linkage was performed among the CR, administrative databases, and pathology reports (AP), considering clinical events within ±180 days from incidence date. Clinical information (diagnoses, pharmacological therapies, surgical procedures, causes of death, pathology codes) was transformed into chronological clinical tokens concatenated into a single string. The target variable was the combined topo-morpho code assigned by registry coders. An LSTM neural network (embedding=64, hidden=128) was trained to learn token sequences. SETTING AND PARTICIPANTS:incident cancer cases recorded by the Cancer Registry of the Agency for Health Protection of the Metropolitan Area of Milan in 2017-2018; multiple, benign, and uncertain tumors were excluded. Main outcome measures: accuracy in the prediction of topography, morphology, and combined topo-morpho. Precision, recall, and F1 score at different confidence thresholds. Secondary analysis for high-incidence cancer sites and identification of the most predictive tokens and information sources. RESULTS:the dataset included 34,168 cases, split 80:20 into training and test sets. On the test set, the model achieved 89% accuracy for topography prediction, 59% for morphology, and 56% for the combined topo-morpho classification. Performances were better for highly frequent sites (breast 73%; colorectal 61%). For lung and prostate cancers, accuracy for topography reached 94% and 98%, respectively. The most predictive tokens and information sources were identified: pathology reports, mortality data, and surgical procedures for topography; pathology reports, hospital discharge diagnoses, and mortality for morphology. CONCLUSIONS:the LN-PDTA-based neural network approach shows promising results for the most frequent topographies and morphologies, thus enabling automatic coding of a fair number of cases, reducing manual coding time and supporting more efficient cancer registry operations.
BACKGROUND:migration is reshaping the epidemiology of chronic diseases in Europe. Although ethnicity is a known determinant of diabetes burden, evidence on diabetes prevalence, care pathways, and mortality across different migrant groups remains limited. OBJECTIVES:to compare diabetes prevalence, clinical management, and mortality between Italians and migrants from High Migration Pressure Countries (HMPC) in Reggio Emilia (Northern Italy). DESIGN:population-based study with a cross-sectional analysis and a cohort analysis. SETTING AND PARTICIPANTS:the data used in this study have been extracted from the Reggio Emilia Diabetes Registry and stratified by geographic area of citizenship: Italy, High Developed Countries (HDC), and HMPC (further divided by geographic area). Principal outcome measures: a cross-sectional analysis (31.12.2024) was performed to estimate age-standardized prevalence of Type 1 (T1DM) and Type 2 diabetes (T2DM) and to assess care management indicators (shared care vs exclusive specialist care) among residents. Additionally, a cohort analysis (2019-2024) evaluated all-cause mortality. Hazard ratios (HRs) were estimated by Cox proportional hazards models. RESULTS:T2DM age-standardized prevalence was significantly higher in HMPC citizens compared to Italians (females: 9.7% vs 5.0%; males: 11.4% vs 7.7%), peaking in South Asians (F: 18.3%; M: 15.7%). By contrast, T1DM prevalence was lower in HMPC. Regarding management, immigrants were less likely to be under formal diabetes care compared to Italians; when treated, HMPC patients were more frequently managed exclusively by specialist clinics rather than through shared care with General Practitioners. T2DM was associated with increased all-cause mortality in all groups. Compared to their non-diabetic counterparts, the excess mortality risk was higher in specific migrant groups than in Italians (HR 2.25): East Asians (HR 5.69), and South Asians (HR 3.15) showed the largest survival disadvantage. Among non-diabetic individuals, the survival advantage typically associated with the 'healthy migrant effect' was not observed in people aged under 50. CONCLUSIONS:substantial heterogeneity exists in diabetes burden, care organization, and mortality across migrant groups. Differences likely reflect both biological susceptibility and structural barriers to primary care access. Tailored public health strategies are needed to reduce inequalities in diabetes outcomes.
On 30 January 2025, the European Court of Human Rights condemned the Italian Government for failing to safeguard the right to life of residents in ninety municipalities in the Campania region, an area known as 'Terra dei Fuochi' (literally: Land of Fires). This judgment is historic for two main reasons. First and foremost, it represents the first judicial recognition of severe, decades-long environmental and health deterioration affecting a specific territory. Second, it establishes a significant precedent for environmental litigation, marking the first time the Court has unequivocally affirmed that epidemiological evidence collected within a defined area is sufficient to demonstrate a violation of the right to life of the populations living there. This stance adopted by the Court gives rise to a series of important legal implications: it strengthens the basis for prosecuting environmental crimes and encourages the development of innovative investigative projects that move beyond individual-level data; such projects can capture the collective harms suffered by affected communities and help determine whether these harms can be traced to actions or omissions by public authorities or private-sector actors.
OBJECTIVES:to describe the frequency of prostate biopsy and its determinants, as well as the incidence of prostate cancer, in a cohort of asymptomatic residents of the Agency for Health Protection of the Metropolitan Area of Milan (ATS Milano) who underwent total prostate-specific antigen (PSA) testing. DESIGN:cohort study of resident men aged 30-84 years who underwent at least one PSA test (index test) in 2018-2019 and 2021-2023, with follow-up until December 2024. SETTING AND PARTICIPANTS:from the administrative and healthcare databases of ATS Milano, 414,731 residents who underwent at least one PSA test during the study period, presumably for screening purposes, were identified. MAIN OUTCOME MEASURES:frequency of specific follow-up procedures (repeat PSA testing, urological consultation, ultrasound, magnetic resonance imaging), with particular focus on prostate biopsy, and cumulative incidence at 3, 6, and 12 months after the index test. Logistic regression analysis of the probability of undergoing prostate biopsy within 6 months of the index test. RESULTS:overall, 1.6% of subjects underwent a prostate biopsy within one year (N. 6,598). This proportion increased markedly with higher initial PSA values (13.8% among those with PSA >=6 ng/mL). On average, 11.7% of biopsies were the first procedure after the index test, 22.4% followed one of the procedures considered, 33.7% followed two procedures, 24.9% followed after three procedures, and 7.3% followed four procedures. Prostate cancers diagnosed were 1,157 at 3 months and 3,219 at 1 year, compared by means of the observed-to-expected ratio, to the incidence of the general population. The biopsy-to-cancer ratio was approximately 2. At 6 months, prostate biopsy was positively associated with age (up to 70-79 years), strongly associated with PSA level (>=6 ng/mL, OR: 28.7) and with Italian citizenship, while a lower risk was observed in the presence of comorbidities. The observed-to-expected ratio was greater than 1 for initial PSA values >=3 ng/mL and increased progressively with higher PSA levels. CONCLUSIONS:among residents of the ATS Milano area, a PSA level equal to or greater than 3 ng/mL identifies an early increased risk of prostate carcinoma. To ensure the timely identification of all clinically significant cases, biopsy should be integrated into a multimodal diagnostic pathway including advanced imaging, which was not always available in the analysed cohort.
The web of causation of the upper airways cancers (UAC) is complex and, at present, only partially defined; certainly, a wide range of airborne viruses and chemicals is therein (with varying degrees of evidence) involved. Within the perspective of subsequent formal studies about this topic, a small case-series pilot has been performed, searching Epstein-Barr Virus (EBV), Human Cytomegalovirus (HCMV), Human Papilloma Virus (HPV) 18 and 16 markers in a set of tumour samples from 53 patients diagnosed with different types of primary epithelial UAC. Overall, the prevalence of positive tests for EBV, HCMV, and HPV18 was 24.5%, 5.5% and 5.5%, respectively. EBV tested positive in 10 nasopharyngeal carcinomas (including 1 adenocarcinoma), 2 nasal carcinomas (including 1 adenocarcinoma), and 2 sinus carcinomas (both adenocarcinomas); HCMV tested positive in 3 nasal carcinomas (including 2 adenocarcinomas); HPV18 tested positive in 1 nasal adeno carcinoma and 2 sinus adenocarcinomas. Future studies are warranted to shed light on the complex aetiology of UAC, by integrating the best pathological evidence and systematic acquisition of standardized anamnestic data, meanwhile taking in consideration both the viral presence in the cancer tissues and the patients' self-referred exposures to particles and vapours.
OBJECTIVES:to provide a comprehensive and comparable assessment of life expectancy (LE), health-adjusted life expectancy (HALE), Years Lived with Disability (YLDs), Years of Life Lost (YLLs), and Disability-Adjusted Life Years (DALYs) across Italian regions from 1990 to 2023, identifying temporal, geographical, and sex-specific patterns to inform targeted public health strategies. DESIGN:descriptive epidemiological study using estimates from the Global Burden of Disease Study (GBD) 2023. SETTING AND PARTICIPANTS:the analysis covered the Italian population, stratified by sex, five macro-regions, and 21 subnational locations, including 19 Regions and 2 Autonomous Provinces. MAIN OUTCOME MEASURES:LE, HALE, all-age and age-standardized rates YLDs, YLLs, and DALYs per 100,000 population; all estimates were presented with their 95% uncertainty intervals. RESULTS:between 1990 and 2023, LE increased substantially across all regions and in both sexes, despite the temporary decline associated with the COVID-19 pandemic. In 2023, the highest LE was recorded in the North-East, with 81.4 years (95%CI 81.1-81.6) for males and 85.8 years (95%CI 85.6-86.1) for females, while the lowest values were found in the Islands, at 79.7 years (95%CI 79.3-80.1) for males and 84.2 years (95%CI 83.9-84.5) for females. However, differences diminished when considering HALE. YLDs increased steadily over time, reflecting not only population ageing but also the expanding burden of chronic and non-fatal conditions. In contrast, YLLs declined markedly in both sexes, driven particularly by substantial reductions in mortality from neoplasms and cardiovascular diseases. However, in 2023, ischemic heart disease remained the leading contributor to all-age DALYs among males, while Alzheimer's disease was the top cause among females. Anxiety disorders represented the leading cause of age-standardized DALYs in females and showed marked increases since 1990. Among males, ischemic heart disease continued to appear as the primary cause of age-standardized DALYs. CONCLUSIONS:health in Italy improved substantially over the past three decades, primarily due to declining premature mortality. However, the burden of disability increased, particularly among women, and important geographical and sex-specific inequalities persist. Strengthening prevention policies, addressing behavioural and metabolic risk factors and mental health, improving long-term care, and promoting healthy ageing are essential to reducing health disparities.
OBJECTIVES:to evaluate follow-up patterns after a total prostate-specific antigen (PSA) test performed in the absence of clinical indications among residents of the Agency for Health Protection of the Metropolitan Area of Milan (ATS Milano). DESIGN:a cohort of men aged 30-84 years residing in the ATS Milano area who underwent at least one PSA test between 2018-2019 and 2021-2023, followed for subsequent investigations through December 2024. SETTING AND PARTICIPANTS:from the administrative and healthcare databases of the ATS Milano, 414,731 individuals who had at least one PSA test during the study period, presumably for screening purposes, were identified. MAIN OUTCOME MEASURES:individual procedures and cumulative follow-up activities within 3, 6, and 12 months from the index PSA test, classified as passive or active, and as conservative (repeat PSA test, ultrasound, or urological visit) or aggressive/therapeutic (CT/MRI imaging, prostate biopsy, or prostate-related hospitalization). Logistic regression was used to estimate the probability of active and aggressive follow-up. RESULTS:overall, 58% of men had no follow-up procedures within the first year, particularly among those with low PSA values, while the proportion remained above 30% among men with PSA >=4 ng/mL. Among those who underwent follow-up, 84% followed a conservative pathway. At one year, among men aged 50-69 years (55.7% of the total population) with PSA >=3 ng/mL, 38.8% had no follow-up, while 18.7% underwent an aggressive procedure, compared with about 5% among those with PSA <3 ng/mL. Within three months, the most frequent procedures were urological consultation (10.0%) and ultrasound (9.3%). The probability of active follow-up increased with age (including advanced age), index PSA value, >=3 comorbidities, and socioeconomic deprivation. Older age, PSA >= 4ng/mL, and Italian citizenship were associated with a higher likelihood of an aggressive approach. CONCLUSIONS:the high rate of active follow-up among older adults (70-84 years) with multiple comorbidities, even with a lower use of aggressive procedures, indicates the value of an organised programme aimed at concentrating interventions on individuals who are most likely to benefit.
BACKGROUND:the association between air pollution and human health has been extensivelyinvestigated in the epidemiological literature. However, evidence in non-urban areasaffected by industrial activities is still limited. OBJECTIVES:to assess the association between daily exposure to PM10 and cause-specific mortality in municipalities affected by emissions from industrial plants during the period 2006-2015. DESIGN:two-stage time-series design was applied to assess the relationship between lagged PM10 and the outcomes. In the first stage, the association at the municipal level was analyzed with Poisson regression models adjusted for space-time confounders (trend and temperature). In the second stage, a mixed effects metanalysis of municipal estimates was applied to obtain a pooled estimate. Effect modification for individual variables (sex, age) and type of industrial site (chemical, steel, energy, or mining plant) was assessed. SETTING AND PARTICIPANTS:using the European Pollutant Release and Transfer Register, industrial plants entailing a combustion process were selected. 4x4 km² buffer around the plant was constructed to select the municipalities to be included in the analysis. Daily PM10 was estimated using machine-learning models based on satellite data. MAIN OUTCOMES MEASURES:daily counts of natural, cardiovascular, and respiratory deaths. RESULTS:the average exposure to PM10 was 28.4 μg/m³ (±SD 16.9). During the period under study, 568,804 deaths from natural causes were observed in the 100 municipalities near the 61 industrial sites identified. Percentage risk variations for 10-units increments of lagged 0-1 PM10 were 1.04% (95%CI 0.67;1.41), 1.04% (95%CI -1.21;3.34), and 7.89% (95%CI 0.16;16.23) for natural, cardiovascular, and respiratory mortality, respectively. Higher risk estimates were observed in municipalities near steel plants, especially for respiratory mortality (8.13%; 95%CI -2.85;20.35). No differences were observed in estimates between different age and sex classes. CONCLUSIONS:although not fully able to capture the industrial component of pollution, the results indicate excess risk of mortality in residents of the municipalities under study, especially when considering the presence of steel plants.
BACKGROUND:in 2016, based on data 2000-2012, using gender-specific age-cohort models, the number of mesothelioma cases in Lombardy were predicted for the period 2013-2029. OBJECTIVES:to evaluate accuracy forecasts for the years 2013-2024; to examine the characteristics of affected subjects and to calculate incidence rates for the years 2000-2021. DESIGN:incidence study. SETTING AND PARTICIPANTS:Lombardy Region (Northern Italy); individuals recorded in the Lombardy Mesothelioma Registry. MAIN OUTCOME MEASURES:mesothelioma incidence. METHODS:the number of observed and predicted cases was compared for the years 2013-2024. Moreover, cases observed in 2000-2021 (years in which all registry activities have been completed) were selected from the registry database, their clinical characteristics and asbestos exposure were described, and crude and age-standardized rates (ASR) were calculated by year and Province of residence. RESULTS:in the years 2013-2024, 3,588 cases were observed in men, 435 more than the predicted value; in women, 1,671 cases were recorded, 90 less than the predicted value. The yearly number of cases was constant in men and slightly declining in women. In the period 2000-2021, 8,437 cases (7,922 pleural mesotheliomas) were recorded and evaluated, 5,568 in men and 2,869 in women. Evidence of occupational exposure was found for about two thirds of men and for one third of women. Most men had been exposed to asbestos in metalworking and metallurgy industries (35.4%) and in the construction sector (33.7%). Most women had been exposed in non-asbestos textile (53.3%) or clothing (13.4%) industries. In both genders, rates decreased for ages below 70 years, were stable for ages 70-74 years, and increased for ages 75+ years. In both genders, the highest rates were recorded in Pavia Province, where an asbestos cement factory had been operating for a long time. CONCLUSIONS:a fair agreement between observed mesothelioma cases and forecasts as of 2024 was found. The peak occurred in 2013, but in the following years there was no indication of decrease of yearly cases in men and only a slight decrease in women. The highest disease burden concerns individuals aged 75 years or more. Data from this paper indicates that in 2025-2029 in Lombardy there still will be between 350 and 400 cases per year.
OBJECTIVES:to investigate pesticide residues in private gardens near crops in the province of Verona (Veneto Region, Northern Italy) and assess potential risks to human and environmental health. DESIGN:cross-sectional observational study based on a participatory research approach. SETTING AND PARTICIPANTS:fifty residential gardens located within 40 metres of cultivated fields, selected through community engagement activities. MAIN OUTCOME MEASURES:detection frequency, type, and concentration of pesticides in deciduous leaves; assessment of associated toxicological risk levels. RESULTS:pesticides were found in over 70% of the samples analysed. Folpet-phthalimide was the most frequently detected compound (55.3%). Several hazardous substances were found within distances below those recommended by regional guidelines. CONCLUSIONS:the findings highlight shortcomings in current protection measures against pesticide drift. Participatory environmental monitoring can strengthen prevention strategies and support public health action.
OBJECTIVES:to assess the frequency of total prostate-specific antigen (PSA) testing in the absence of clinical conditions in the Agency for Health Protection of the Metropolitan Area of Milan (ATS Milan), prior to the launch of the Lombardy regional prostate cancer screening programme. DESIGN:the study included all men aged 30-84 years residing in the ATS Milan area who underwent at least one PSA test during the years 2018-2019 and 2021-2023. The absence of prostate-related clinical conditions was verified using local health records and the cancer registry of the ATS Milan. SETTING AND PARTICIPANTS:the study used data from administrative and healthcare databases of ATS Milan. Among the 466,616 citizens with at least one PSA tests recorded during the study period, 414,731 had the test presumably conducted for screening purposes. MAIN OUTCOME MEASURES:at least one PSA test in the period. RESULTS:screening tests accounted for approximately 80% of total PSA tests. On average, 35.6% of male residents underwent at least one preventive PSA test, with low uptake among those under 50, 48.9% in those aged 50-69 years, 60.8% among men in their seventies, and 51.8% in the 80-84 age group. The mean number of PSA test per individual over the study period was 2.3. Testing decreased in 2021-2022, but increased again in 2023. A significant and increasing proportion of individuals undergoing PSA testing had three or more comorbidities. Among the 414,731 initial tests, 47.3% had PSA values <1 ng/mL, 35.4% between 1 and 3, 11.0% between 3 and 6 and 6.3% >=6. CONCLUSIONS:the high frequency of testing among the elderly, the frequent repeat testing, and the growing involvement of individuals with multiple comorbidities highlight the need to transition to an organized screening programme capable of balancing benefits and risks.
Background: survival rates for childhood cancers have significantly improved over recent decades, with 5-year survival now approaching 90 degrees%o for many types. However, documented variations in survival across European countries and Italian regions highlight the need to address inequalities. One of the most critical prognostic factors is the extent of tumour spread at diagnosis (tumour stage). Objectives: the BENCHISTA-ITA aims to enhance understanding of regional differences in childhood cancer survival and to promote the widespread adoption of the Toronto Guidelines (TG) by Italian cancer registries for the most common solid paediatric tumours. Design: the study will examine stage distribution and survival for nine solid paediatric cancers: medulloblastoma, neuroblastoma, Wilms tumour, retinoblastoma, and ependymoma (age: 0-14 years), as well as astrocytoma, osteosarcoma, Ewing sarcoma, and rhabdomyosarcoma (age: 0-19 years). Setting and participants: the study will include all children under 15 or 20 years (depending on the tumour type) diagnosed between 01.01.2013 and 31.12.2017, with relevant histological codes. Participating Italian cancer registries will assign tumour stage at diagnosis using the Toronto Guidelines. Statistical analysis: the statistical power to detect differences in stage distribution and survival rates among regions is limited by the number of incident cases per tumour type and region. Therefore, analyses will be descriptive, with 95 degrees%o confidence intervals. Overall survival for each tumour type will be estimated using the Kaplan-Meier method. Conclusions: BENCHISTA-ITA represents an important step toward a more complete and standardized regis tration of childhood cancers in Italy. The results may support targeted interventions to reduce inequalities and improve outcomes for paediatric patients.
BACKGROUND:gambling is a widespread phenomenon among adolescents, with increasing prevalence among preadolescents. OBJECTIVES:to describe the prevalence of gambling and problematic gambling in a sample of secondary school students of Piedmont Region (Northern Italy) and Lazio Region (Central Italy) which participated in the "GAPUnplugged" experimental study. METHODS:data were collected through an anonymous questionnaire created ad hoc and administered between November 2022 and January 2023. Prevalence of gambling in the past 12 months and 30 days and of problematic and at-risk behaviour measured through the SOGS-RA scale were estimated. RESULTS:1,874 students aged 12 to 14 participated in the study. Prevalence of gambling was 55.7% in the last 12 months and 36.4% in the last 30 days. Sixteen percent of students engaged in regular gambling (3 or more times in the last 30 days), 7.2% had at risk gambling behaviour, and 3.4% had problematic gambling behaviour. Prevalence was higher among males and among students of schools of the city of Rome. CONCLUSIONS:gambling among preadolescents is a widespread phenomenon, with a proportion of students at risk or exhibiting problematic behaviours similar to other addictive risk behaviours. It is needed to create and implement specific preventive interventions to limit early exposure to gambling in adolescence and preadolescence.
The one health approach provides a conceptual framework capable of activating multidisciplinary competences and skills in an original way in order to limit the threats that endanger life and the planet's ecosystems. There are many applications in the environmental and health fields, while interest is growing in the epistemological, ethical, and philosophical fields. The topic of communication is explored and illustrated with examples that clarify its dimensions and links to governance issues.
Juvenile prisons represent a jumble of dilemmas and choices for those concerned about the health and future of young detained people. While often presented as an opportunity for "rescue" and even social redemption, juvenile justice facilities offer a variety of approaches, ranging from the more advanced ones that allow effective interactions with the "outside" (family, school, and the world of work) to the more closed ones where the lack of support and activities exposes the most serious aspects of any incarceration: violence, isolation, and various forms of addiction. Italy's main and largest juvenile prison, named after Cesare Beccaria (an Italian philosopher universally renowned for laying the conceptual foundations against the death penalty and torture), has been experiencing a period of great difficulty for years, characterized by widespread violence, inadequate care for the needs of young people in prison, staff frustration, and social criminalization of inmates, accompanied by the stigmatization of those who work there. The author analyses the risks for young people detained in such places and invites to reflect about what general conclusions can be drawn about juvenile prisons in today's Italian society.
OBJECTIVES:to review pneumococcal vaccination recommendations in at-risk adults and people aged 65 years or over across the Italian Regions. DESIGN:mapping review of available online resources, both at regional and local health unit level, on pneumococcal vaccination programmes by age and risk group. SETTING AND PARTICIPANTS:the review included institutional websites of regional and local health authorities, freely accessible to the public via generic search engines, containing information on pneumococcal vaccination in frail people. MAIN OUTCOME MEASURES:the following information was collected and classified: • populations targeted by the immunization programme; • type of recommended vaccine (conjugate and/or polysaccharide); • adopted vaccination schedule; • mode of patient contact; • involved health professional; • availability of vaccination registry; • availability of vaccination coverage data; • presence of online awareness campaigns. RESULTS:a total of 24 institutional websites, representative of all Italian Regions, were included in the review. More than 90% of the recommendations collected were published between 2023 and 2024. In 75% of the analyzed documents, the Regions offer pneumococcal vaccination to the cohort aged 65 years; in 46% of the documents, the offer is extended to all persons aged 65 years and over. In 96% of the resources, the vaccination programme includes at-risk adults, and 75% of these give details of the diseases for which vaccination is recommended. In seven resources, it is reported that Regions recommend a single dose of the 20-valent pneumococcal conjugate vaccine, in the others the use of the pneumococcal conjugate vaccine (PCV) followed by the 23-valent pneumococcal polysaccharide vaccine (PPSV23) is indicated, with different schedules. In at-risk adults, 83% of the documents recommend the sequential schedule with PCV followed by PPSV23, with time schedules defined in 63% of cases. The mode of patient contact is reported in 7 web resources, 4 of which include sending an invitation letter at 65 years of age. Vaccination center health professionals (16/24) and general practitioners (15/24) are the healthcare providers most involved in promoting and administering vaccination. In 71% of the resources, the regional health authorities were reported to have promoted targeted communication campaigns. Data on PCV coverage by age were available for 6 Regions, but not by risk group. CONCLUSIONS:the findings of this study highlight significant heterogeneity in the offer of pneumococcal vaccination to at-risk adults and people aged 65 years and older among Italian Regions. Greater efforts are needed to standardize and harmonize vaccination policies and to coordinate vaccination communication. The integration of immunization registries with high-risk patient clinical data will allow the systematic identification of vaccine candidates and facilitate the monitoring of vaccination coverage.
Problematic smartphone and social media use among adolescents has rapidly become a social emergency with significant mental health implications. Recent studies show an increase in psychiatric symptoms and suicidal behaviors related to patterns of addictive use rather than total exposure time. This phenomenon, amplified by neurocognitive reward mechanisms and the possibility of continuous access, compromises attention, sleep, and interpersonal skills. Prevention strategies are structured on three levels: technical and legal control (use restrictions and school bans), educational and family empowerment (digital education and family use plans), and health prevention through screening and counseling. The article concludes with the hope for a change in strategy: not only limiting use, but also fostering a conscious and critical relationship with technology through coordinated, evidence-based policies.
BACKGROUND:when facing growing environmental and social challenges, it is essential to involve citizens and social actors to increase the probability of success of the interventions, after establishing a cohesive and harmonised working group. OBJECTIVES:to illustrate the tools for risk communication activity developed as part of the 'One Health Citizen Science' Project (OHCS), the actions undertaken and the preliminary results that offer an overview of the context and perspectives; to analyse the results of the internal survey of the group of experts working in OHCS on the issues of risk perception and communication in the specific context of citizen science (CS). DESIGN:description of the actions undertaken in the OHCS communication sector and a transversal study on risk perception and CS. SETTING AND PARTICIPANTS:within the OHCS project, the following tools were produced during various meetings: information sheets, to be compiled for each of the 7 polluted sites and the 2 regional waste plans, containing useful information for setting up a risk communication programme; a methodological document for risk communication, to be used as a guide for the construction of specific communication plans in each area; an internal questionnaire, consisting of 29 questions to deepen the knowledge of the project partners, administered through the Google Forms platform. MAIN OUTCOME MEASURES:description of the actions undertaken in the OHCS communication sector and a transversal study on risk perception and CS of the experts, part of the project team; quantitative and qualitative analysis of the information sheets; evaluation of the impact of the methodological document for risk communication; analysis of the data obtained from the internal questionnaire, through descriptive statistical methods and multivariate analysis, implemented with R Software. RESULTS:the information sheets contain useful information for risk communication, but need to be updated. The methodological document is still only partially used. The internal questionnaire administered to the experts of the project team saw the participation of 46 adults (between 30 and 59 years old: N. 35; 76,09%), mainly female (N. 31; 67,39%), with a high level of education. The results confirm the awareness, expected in sector operators, that dangers involve risks and reinforce the indication to work directly to mitigate them. Over two thirds of respondents have not participated in CS projects, and the majority declared themselves convinced that there are protection and prevention measures that can be implemented immediately, involving the responsible authorities and providing widespread information dedicated to different stakeholders. CONCLUSIONS:the OHCS project, launched in 2023, has developed useful tools for collecting information and preparing environmental monitoring and biomonitoring activities. The results obtained so far show an improvement in the quality and quantity of the information collected, which is useful for involving social actors. The approaches used promote systematic methodologies that can facilitate the participation of all stakeholders. Internal communication actions within the project have contributed to the consolidation of the project team and the mapping of citizens' social actors, and have developed awareness of the importance of CS for the planned activities and replicability in other contexts.
BACKGROUND:maintenance immunosuppressive therapy, indicated for patients after solid organ transplantation - kidney (R), liver (F), heart (C), lung (P) - and aimed at preventing rejection, involves the intake of at least one Calcineurin (CNI) inhibitor (Cyclosporin - CsA - or Tacrolimus - TAC) in combination with an Antimetabolite (Antim) (Mycophenolate Mofetil or Mycophenolic Acid - MMF - or Azathioprine - AZA) or a proliferation signal inhibitor (mTOR) (Sirolimus - SIR - or Everolimus - EVE) with the possible addition of corticosteroids (in particular Prednisone - PRED). The possibility of comparing prescribing patterns identified through different data sources represents an important methodological challenge and could shed light on the accuracy, advantages, and limitations of different information sources, aspects that must be considered when planning future observational studies. OBJECTIVES:to assess, within a cohort of solid organ transplant patients, the levels of concordance in the definition of post-transplant immunosuppressive therapy between health administrative flows and what is reported by the medical specialist during the patient's periodic follow-up visit. DESIGN:analysis of the level of concordance of information on post-transplant maintenance immunosuppressive therapy collected from two different data sources: the regional health administrative databases (SIS) and the national transplant information system (SIT). This analysis was performed as part of a retrospective cohort study - the CESIT study - including all patients undergoing single solid organ transplantation (heart, liver, lung, kidney) between 2009 and 2019 in four Italian regions (Lombardy, Lazio, Veneto, Sardinia). The therapeutic combinations of immunosuppressants were identified by means of specific algorithms applied to the SIS data and subsequently compared with the therapeutic patterns recorded by specialist physicians during follow-up visits (FU) and entered electronically in the SIT flow sheets. The analysis focuses mainly on the therapy delivered in the 30 days following hospital discharge (index therapy); it is then extended to comparisons made over longer time windows (at 1, 2, and 3 years from the date of hospital discharge). MAIN OUTCOME MEASURES:the level of agreement between the two data sources in defining the index therapy was assessed using three methods: 1. Cohen's k statistic: this method allowed quantification of the level of agreement at the level of individual active substance; 2. proportion of active ingredients in common: an ordinal categorical variable was calculated for each patient indicating the level of concordance between the sources: null (no active ingredient in common), low (<40 % of ATCs in common), medium (40-59 %), high (>60 %), perfect (identical combinations); 3. Levenshtein distance (LS): considering polypharmacies from a formal point of view as strings, the computational effort that would be required to make them equal was estimated. RESULTS:there were 2,692 solid organ transplant patients for whom index therapy information was available from both SIS and SIT (C: 6.8%; F: 44.9%; P: 5.2%; R: 43.1%). In comparison to CNI immunosuppressants, Cohen's k coefficient showed high levels of concordance for all transplant types (CsA heart: 0.78; CsA liver: 0.96 - TAC heart: 0.74; TAC kidney: 0.92); while for MMF, differential performance by organ type was evident (MMF heart: 0.51; MMF kidney: 0.78). For the Preds, there was greater discordance in particular in R and F. When comparing immunosuppressive therapy as a whole, the 'high/perfect' concordance levels concerned on average 80.1% of the patients (F: 70.1%; R: 91.3%). The results were comparable by applying LS. Finally, the concordance at 1, 2, and 3 years after discharge reported a less good performance than with index therapy, which was, however, stable over the time intervals considered. CONCLUSIONS:the level of concordance between therapeutic combinations for the same patient detected between different sources was generally high: despite this, the level of agreement varied according to the individual active substance, the type of transplant and the time window examined. The results of this work show that SIS are a valuable tool for defining immunosuppressive maintenance therapies and offer useful elements to consider when planning observational studies based on the two data flows.
Objectives: to provide the epidemiological framework of those affected by rare diseases resident in the Campania Region (Southern Italy), using the data entered in the Campania Region Rare Disease Registry, acquiring information potentially useful for regional planning. Design: observational retrospective cohort study on patients with rare diseases included in the Regione Campania Rare Disease Registry from 01.01.2022 to 31.12.2022. Setting and participants: population included in the Rare Disease Registry and resident in the Campania Region as at 31.12.2022. Main outcome measures: using the data entered in the Regione Campania Rare Disease Registry, the cumulative incidence (I) of patients with rare diseases resident in Campania was calculated, stratified by age group and rare disease group with the respective 95% confidence intervals (IC95 degrees%o). Standardised cumulative provincial incidences were also calculated. These are reported using a multiplication factor of 100,000. Results: the incidence of patients with rare diseases in the Campania Region is 50.0 (IC95 degrees%o 49.4-50.6) per 100,000 inhabitants in the year 2022. Furthermore, the rare disease groups with the highest incidence per 100,000 inhabitants are diseases of the central and peripheral nervous system (I: 8.32 per 100,000 inhabitants) and congenital malformations, chromosomopathies and genetic syndromes (I: 8.52 per 100,000 inhabitants). Moreover, the age groups in which the incidence is highest are in the paediatric age group. Conclusions: an epidemiological framework of the Campania Region on rare diseases such as this one for the year 2022 is fundamental for national and regional planning in order to improve the care and quality of life of people affected by rare diseases, who often feel neglected by society. Sharing this type of information also draws attention to the need for faster diagnosis and the specialisation of new centres.
